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Trump's health care 'vision' punts on two major issues

President Donald Trump is touting what he calls his health care "vision," but the executive orders he's planning to sign Thursday afternoon largely punt on addressing two major issues facing Americans.

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Tami Luhby
Maegan Vazquez, CNN
CNN — President Donald Trump is touting what he calls his health care "vision," but the executive orders he's planning to sign Thursday afternoon largely punt on addressing two major issues facing Americans.

The measures, which fall far short of a comprehensive proposal, come less than six weeks before the presidential election and serve as a political play to shore up concerns at a swing state event. Democratic nominee Joe Biden has already committed to making health care a focal point of the rest of his campaign, highlighting Trump's actions to dismantle the Affordable Care Act and the unprecedented protections the law already provides for people with pre-existing conditions.

The President is also looking to shift attention away from criticism of his handling of the coronavirus pandemic. More than 200,000 Americans have died from the virus over the past six months.

The first executive order will state that it's US policy that people who suffer from pre-existing conditions will be protected, Health and Human Services Secretary Alex Azar said in a call with reporters.

The President and Republican lawmakers have repeatedly said they will safeguard these Americans, even as they try to tear down the Affordable Care Act that already protects them. Azar declined to specify how the administration would guarantee these protections if the Supreme Court overturns the landmark health reform law in a case it will consider this term.

The second executive order directs Congress to pass legislation to address surprise medical billing by the end of the year, and if lawmakers don't achieve this, Azar will seek to do so via executive or regulatory action.

Trump already called for an end to the practice in a 2019 speech and in his State of the Union address earlier this year. Though lawmakers on both sides of the aisle agree, legislation has been stymied by differing views on who should cover the tab -- insurers or providers.

The orders are the latest health care-related actions Trump has taken in recent weeks as he seeks to take back control of the issue from Biden. Health care rocketed into the spotlight again with the death of Supreme Court Justice Ruth Bader Ginsburg on Friday, which heightens the uncertainty surrounding the Affordable Care Act's fate in the nation's highest court. The justices will hear oral arguments on a case seeking to take down the law on November 10, one week after the election. The Trump administration has asked the court to invalidate Obamacare.

Though the President has repeatedly promised to roll out a health care proposal, the administration has decided to bill the wide variety of measures Trump has taken as his vision.

Azar and other administration officials ticked off a long list, including efforts to broaden less-expensive alternatives to the Affordable Care Act, to require hospitals to disclose prices they negotiate with insurers and to improve Americans' kidney health. They emphasized that Americans insured through Medicare Advantage and Affordable Care Act policies have seen premiums drop and the choice of plans increase under the President's watch.

Protecting those with pre-existing conditions

The Affordable Care Act's protections for those with pre-existing conditions have proved among its most popular provisions. Democrats' defense of the law helped them capture control of the House in 2018.

The protections include barring insurers from denying coverage or charging higher premiums to people based on their medical history -- both common practices in the individual market prior to Obamacare. An estimated 54 million Americans -- or 27% of non-elderly adults -- have conditions that would have rendered them uninsurable under the old system, according to the Kaiser Family Foundation.

The law also requires insurers to provide comprehensive benefits in the individual market and bans them from imposing annual or lifetime limits on coverage.

Though the President has said repeatedly that he will continue these protections, his actions say otherwise. The administration is largely backing a coalition of Republican-led state attorneys general, who say that Obamacare's individual mandate was rendered unconstitutional when Congress reduced the penalty for not having insurance to zero in 2017. As a result, the entire law must fall, they contend. This case is now before the Supreme Court.

Administration officials also contend that Obamacare doesn't truly protect those with pre-existing conditions because its premiums and deductibles are unaffordable. However, Trump's alternative -- short-term health plans, which he expanded through an executive order in 2017 -- come with lower monthly premiums in large part because these policies don't have to adhere to the Affordable Care Act's regulations.

Also, the President's efforts to continue the protections do little to help people afford health insurance should Obamacare be declared unconstitutional. The act provides generous subsidies to low- and moderate-income Americans to buy policies on the Affordable Care Act exchanges and supports states that expand Medicaid to low-income adults. Some 38 states, plus the District of Columbia, have broadened Medicaid or passed ballot measures to do so.

Ending surprise medical billing

The President has also spoken several about solving the problem of surprise medical billing, another one of Americans' big health care concerns.

Patients are often hit with surprise medical bills when they receive emergency care from an out-of-network provider that they did not choose. Roughly 1-in-6 emergency room visits or in-hospital stays generated at least one out-of-network bill in 2017, according to the Kaiser Family Foundation.

Efforts to address the issue in Congress have been bogged down amid a lobbying and advertising blitz by the health care industry. Insurers favor the government setting a benchmark rate, but hospitals and other providers -- often backed by private equity firms -- strongly support resolving the matter through arbitration.

Proposals to lower drug prices

In recent weeks, the President has sought to renew attention on his efforts to lower drug prices, one of the main promises of his campaign and first term. The high cost of prescription medicine has long been one of Americans' chief health care complaints.

He has issued four executive orders since late July that largely recycle controversial ideas his administration has proposed in the past, including importing less-expensive medications from Canada and basing the cost of certain Medicare drugs on their prices in other developed nations.

But his measures, which also included calling out drug manufacturers on Twitter, have not resulted in lowering drug prices, though the rate of price growth slowed between 2015 and 2019. Manufacturers hiked prices on 857 drugs by an average of 6.8% in the first six months of this year, according to GoodRx, which follows several thousand brand name and generic medications.

The administration is also committed to giving consumers more information about health care prices as a way to control their growth. Officials issued a historic rule in November requiring hospitals to disclose the prices they privately negotiate with insurers. The measure stems from an executive order Trump issued in the summer of 2019. A district court judge this summer rejected an attempt by a coalition of hospital groups to block the rule, though the hospitals have filed an appeal.

Trump officials have also proposed a separate rule that would require insurers to provide consumers with estimates of their out-of-pocket costs for all health care services through an online tool. Some experts, however, say the rules won't help many consumers because people don't typically shop for medical services.

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